Scotch Dyke Residential Home

We found the following examples of good practice.

The environment had been adapted to encourage social distancing. Communal areas were arranged to enable appropriate spacing between people. People were seen to be enjoying activities and interacting within communal areas without the distance obstructing this.

The home was clean and tidy. A designated housekeeping team worked through allocated parts of the home to maintain cleanliness and good infection control. This included regular cleaning of areas which were frequently touched, for example hand rails and television remotes.

Staff were seen to be wearing appropriate personal protective equipment (PPE), and there was a plentiful supply evident throughout the home.

The provider had policies and procedures for infection prevention and control, which were understood and followed by staff. All staff had received additional training in infection prevention and control and had completed regular competency checks for effective handwashing and the donning and doffing of PPE.

Staff and people were fully engaged in the appropriate COVID-19 testing regime. The test results were clearly displayed in a folder which was checked regularly by the registered manager to ensure the frequency of tests and results were monitored and correct.

The registered manager and clinical lead had been proactive in contacting local health professionals, for example, their local pharmacy throughout the pandemic. This enabled plans to be put in place to ensure people did not run out of medicines when stocks were potentially minimal.

Management spoke highly of staff and their commitment in supporting people during the pandemic. There was a wall in the entrance of the home full of thank you and compliment cards from a wide range of external people, including relatives and members of the local community.

We also identified concerns around consent; consent had not always been gain for the use of equipment by people who may lack capacity. We also saw that capacity assessments had not always been completed. At this inspection we saw that when there were concerns about people’s capacity assessments were completed and when needed people had assessments for the use of equipment such as bedrails.

Concerns were raised about a DNACPR form not being in place for someone who did not have capacity as the forms had not been received from their power of attorney. We spoke with the registered manger and they told us that following the previous inspection this had been rectified in a timely way to ensure that the person’s wishes would be respected. We saw that a DNACPR form had been stored in the persons file.

Another area which required improvement was the provision on activities. There was a lack of meaningful activities for people to take part in, people described the activities as “childish”. We asked the provider to submit an action plan on how they would address these breaches. At this inspection we saw that people’s social needs were assessed and planned for. People spoke positively about the activities with where provided.

At the previous inspection quality assurance within the home also required improvement as they were not sufficient to ensure that the registered manager had oversight and ensure that a high quality care was delivered. At this inspection we saw that a robust quality assurance system was in place which was used to identify and resolved any concerns. At this inspection, we found the provider and registered manager had taken appropriate action and these regulations had been met. As a result, the overall rating for this service has improved from ‘Requires Improvement’ to ‘Good’.

Scotch Dyke Residential Home provides care and support for up to 25 older people with a variety of long term conditions and physical health needs. It is situated in a residential area of Ferring, West Sussex. At the time of our inspection there were 23 people living at the home. People had their own room and rooms were en-suite. There was a dining and lounge area and a garden area that people could access.

The service had a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People were protected by staff who knew how to recognise and report the signs of abuse. Staff had received regular safeguarding training. Safe recruitment practices were followed. Disclosure and Barring Service checks (DBS) had been requested and were present in all checked records. There were sufficient numbers of staff on duty to keep people safe and meet their needs.

People’s rights were upheld as the principles of the Mental Capacity Act and the Deprivation of Liberty Safeguards had been adhered to. The registered manager had made an application for DoLS for one person living at the home.

Staff had undertaken a comprehensive training programme to ensure that they were able to meet people’s needs. New staff received an induction to ensure they were competent to start work. Staff received regular supervisions.

People received enough to eat and drink. People who were at risk were weighed on a monthly basis and referrals or advice was sought where people were identified as being at risk. People had access to a range of healthcare professionals and services.

Staff knew people well and they were treated in a dignified and respectful way. Staff encouraged people to remain as independent as possible. We saw that the guidance in people’s care plans reminded staff to encourage people to be as independent as possible.

The care that people received was responsive to their needs. People’s care plans contained information about their life history and staff spoke with us about the importance of knowing people’s history. Staff knew people well and knew how they liked their care needs to be met.

People’s social and recreational needs were assessed. There were planned and meaningful activities available to people including gardening and baking. There was a greenhouse in the garden which people used to grow their plants. People enjoyed taking part in the activities and also speaking with staff and other people at the home.

Quality assurance systems were in place to regularly review the quality of the service that was provided. There was an open culture at the home and staff told us they would be listened to and supported by the registered manager if they raised a concern. Relatives and staff spoke highly of the registered manager and felt they would be able to approach them with any concerns. Health care professionals also spoke positively and told us "the staff are friendly and welcoming, I recommend the home to my patients".

Scotch Dyke is a residential care home providing accommodation, including respite care, for up to 25 people, a small minority of whom are living with dementia or diabetes and who may require support with their personal care needs. On the day of our inspection there were 23 people living at the home. The home is a large property situated in Ferring, West Sussex. It has a communal lounge and conservatory, dining room and well maintained gardens.

The management team consisted of a registered manager, a deputy manager and team leaders. A registered manager is a ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the home is run.

There were effective systems in place for the storage and disposal of medicines and people told us that they were happy with the support they received. One person told us “If I take tablets the staff give them, I don’t remember, they do”. Another person told us “I can’t remember things so it is important that they do it for me, they keep it in a locked cabinet in the hall, and they are trained”. However, there were concerns regarding the administration and management of medicines. Observations raised concerns regarding staff’s practice when dispensing and administering medicines. Staff did not adhere to the correct procedures when dispensing and administering medication, particularly controlled drugs. Some people had medicines that were prescribed on an ‘as and when required’ basis. There was insufficient guidance available for staff to ensure that people received their medicines consistently and when they were needed. Some medicines, such as liquid medicines and creams, have a limited shelf life. Observations showed that several medicines, which had a limited shelf life, had been opened and no dates had been recorded on the containers to inform staff of how long the medicines had been in use. Therefore people were at risk of receiving out of date medicines that may be less effective or cause them harm. The registered manager demonstrated good practice and enabled people, who were able, to administer their own medicines. However, there was a lack of risk assessments to ensure that the people, as well as others, were safe when people administered their own medicines. These was an area that required improvement.

The registered manager had demonstrated good practice by ensuring that people’s end of life care wishes were discussed and documented. End of life care records for one person showed that the person had made the decision to not be resuscitated. However, the registered manager had not taken timely action to ensure that there was legal documentation in place to ensure the person’s wishes could be respected. This was an area in need of improvement.

People’s consent was gained and staff respected people’s right to make decisions and be involved in their care. The registered manager was aware of the legal requirements with regards to ensuring people who lacked capacity had mental capacity assessments and that they were not deprived of their liberty unlawfully. However, had not ensured that these were in place for all people who lacked capacity. For example, one person, who used bed rails and who lacked capacity to consent to their use, had not had their capacity assessed, nor had their legal representatives been involved in the decision making process to consent to their use. This is an area of practice in need of improvement.

People provided mixed feedback with regards to the provision of activities. Some people told us that they enjoyed talking with other people, reading and resting, whereas other people told us that they were unhappy with some of the activities that were provided as they were too child-like, and chose instead to not partake in them. One person told us “The activities are for little kids, who wants to throw things around, we keep ourselves busy or sleep”. Another person told us “We did have bingo, I liked that, we don’t do the activities, they are silly, but I am not worried, I read”. A third person told us “The bingo and music events are good, but the other stuff is not for me, I don’t want to throw rings on things”. This is an area of practice in need of improvement.

The provider had recognised that the quality assurance processes needed to improve and had recently subscribed to an external organisation to improve the quality assurance systems that were in place. However, current quality assurance systems were not sufficient or frequent enough to enable the registered manager to have sufficient oversight and awareness of all of the systems and processes within the home. For example, there were no care plan audits conducted and therefore delays in the implementation and legal documentation in a person’s care plan was not recognised or acted upon in a timely manner. This is an area of practice in need of further improvement.

There were sufficient numbers of staff to ensure that people’s needs were met and that they received support promptly. When asked why they felt safe, one person told us “I feel very safe, I’ve got my buzzer that I can use if I need help and they come within a couple of minutes, there is plenty of staff about”. Staff were suitably qualified, skilled and experienced to ensure that they understood people’s needs and conditions. Essential training, as well as additional training to meet people’s specific needs, had been undertaken. People told us that they felt comfortable with the support provided by staff. When asked if they thought staff had the relevant skills to meet their needs, one person told us “They seem to, they tell me they do training and they have the qualifications”.

People’s healthcare needs were met. People were able to have access to healthcare professionals and medicines when they were unwell and relevant referrals had been made to ensure people received appropriate support from external healthcare services. One person told us “I need medication, care staff give me my tablets, I see my own doctor, if I need new glasses the optician comes here, which is good, the dentist comes here as well, but if I need important treatment I have to go to the dentist, my daughter takes me”.

People had a positive dining experience and had access to drinks and snacks, of their choice, throughout the day. People told us they were happy with the food, one person told us “The food is good I have no complaints, I have a sherry and crisps each day at this time, I have always liked a small drink, lunch is always a hot meal, supper soup and sandwiches, I don’t get very hungry here”. Another person told us “The food is good, I didn’t particularly like meat before but it is really tender here, it is old fashioned food, pie, fish in sauce, salad, they make a mean omelette, or salad if you don ‘t want what’s on offer”.

Positive relationships had been developed between people as well as between people and staff. There was a friendly, caring, warm and relaxed atmosphere within the home and people were encouraged to maintain relationships with family and friends. People were complimentary about the caring nature of staff, one person told us “The manager is very nice, I like her, I like all the staff, and I talk to all of them”. Another person told us “The staff are wonderful”.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the registered manager to take at the back of the full version of the report.

We found that care was person centred, planned and delivered safely with regular reviews. One person's relative told us that they lived in Switzerland and felt that ' this was a home from home. Nothing was too much trouble and that the staff were wonderful and friendly. They felt confident to have their relative looked after here with them being so far away".

People told us that they felt safe in the home and we found that staff understood their roles and were committed to providing a high quality of care. People said that there were always enough staff available to meet their needs.

We found that the provider had effective systems in place to monitor and assess the quality of the service, which took into account the views of the people, relatives and staff. We saw that the provider used this feedback to make service improvements.

We found that care was planned and delivered safely in line with people's individual needs. A person told us "they understand my needs and they meet them". A person's relative said "we are confident enough to go away on holiday - we are very happy with the way our relative is looked after".

People told us they felt safe in the home, and we found that staff understood their responsibilities to safeguard people from the risk of abuse. People said they were satisfied with the provider's staff and there were enough staff available to meet their needs. The manager told us "this is the residents home, their needs and wellbeing are our priority and we fit around them and do our upmost to help them".

We found that the provider had effective systems in place to monitor and assess the quality of the service, which took into account the views of people, their relatives and representatives. We saw that the provider used this information to make improvements.